How to help my infant sleep
May 13, 2012 12:03 PM   Subscribe

What kind of sleep training book or technique do I need?

My wonderful 14-week-old daughter regularly sleeps through the night, so I am counting my blessings. However (1) I've been repeatedly warned that she'll likely have a sleep regression soon, when she learns object permanence and freaks out to wake up in different circumstances than she fell asleep. I'd like to avoid/minimize that sleep regression. And (2) she only sleeps if she is rocked to sleep and placed very carefully in her crib. If we jostle her a little she often wakes up. Bedtime takes between 45 minutes and 3 hours. Also (3) during the day she only sleeps if she is held the whole time, in a moving car, or on a parent wearing her in a moby or ergo. She doesn't sleep in a swing, for instance, and our bedtime routine doesn't "take" during the day; she wakes up 10-20 minutes after being put in her crib or packnplay.

Our bedtime routine: change, swaddle (sleep sack these days), white noise, (sometimes a book but she's not very interested yet & sometimes a lullaby but it doesn't seem to calm her yet), rocking & nursing (or pacifier). Once she's asleep we wait until she's limp, then put her in her crib without the pacifier. Sometimes she gets a massage and a bath first.

Other facts: Whenever she wakes, she is wet. (My mommy friends can attest my daughter goes through way more diapers than average. She has never once not had a wet diaper overnight and she HATES them with the passion of a thousand suns so we have to change her if she wakes up with one. She is usually ravenous when she wakes up, whether after four hours or ten. I think she has a very strong circadian rhythm. She has never once stayed asleep if put down a minute before 7:45. She wakes up between 5:30 and 7:30 even with blackout blinds, but lately nurses and falls asleep again until about 9. She needs a few long naps a day, and gets them in my arms or through motion.

Our pediatrician says she's ready for sleep training. The pediatrician favors putting babies to bed drowsy almost immediately. That has never worked with our daughter though. She hates to be alone at night, and very rarely falls asleep without sucking on me, a bottle, or a pacifier. During the day she sometimes needs the boob or pacifier to stay asleep for the kind of nap she needs.

I realize we are uncommonly lucky that she often sleeps thrpugh the night now, but I'd like to be proactive because I've read it's much easier to teach a child to fall asleep on their own before they learn object permanence. So what book/technique should I try first? We are open to CIO but not until she's a bit older and we'd prefer to try other effective techniques first.

# 1. Teach her good sleep habits. If possible, make her enjoy going to sleep. Right now she fights it.
# 2. avoid this first sleep regression (I understand she'll likely have more because of teething/illness)
# 3. Napping alone would be great especially when she goes to daycare at 6 months.
# 4. A shorter, more reliable bedtime would be nice.

Thank you in advance oh wise metafilter parents. And happy mother's day to the ladies.
posted by semacd to Human Relations (15 answers total) 3 users marked this as a favorite
1 Stop reading the books you're reading, stop looking for more books, relax; model the desired behaviour, really -- calm happy household of love for a calm happy bedtime. Also, realistic expectations. Did you thrill to bedtime as a kid? Probably not. (It was probably okay when you'd had a tiring-in-a-good-way day and somebody was nice about tucking you in and reading and so on, though.)

2 I'm not even sure what you're worrying about on this one. Lots of people try to sell books on this, but the only one you want to pay attention to is the one that says "all babies are different." The idea that a normal/common stage is a "regression" is a bit silly, no? Whatever you are going through with your baby at any given time will be different in a few weeks no matter what you do, so -- relax and enjoy.

3 Her expectations of day care workers will be very different from her expectations of you. There is no point to trying to create a day-care-ish home environment or anything. She can take every single nap at home nursing to sleep in a sling or she can take every single one crying away, and still day care will not be a parent, and she will grok that even at six months.

4 You have years to go on the reliable bedtime thing, I fear. On the plus (?) side the years will fly by and you will have a creature capable of reasoning with you before you know it. You are really not going to regret getting the cuddles in while you can.

If it is the pediatrician who is worrying you I would consider looking for somebody a little more laid-back and a little less inclined to push an agenda on parents -- you have a physician for pathologies and being told how to parent is perhaps not so useful, especially given that it seems to be giving you some anxiety rather than giving you new and better ways to enjoy parenting. You don't need a book or a technique -- you don't have a problem -- the 'make her enjoy sleep' will follow naturally with her enjoying eating good food, bathing, throwing snowballs, swimming on a hot day, etc, whatever your family engages in joyously.
posted by kmennie at 12:21 PM on May 13, 2012 [5 favorites]

There is nothing wrong with a 14 week old baby wanting a pacifier to sleep. It's very early days still.

1. Some kids love bedtime, some kids hate it. I have one of each. The one who loves bedtime hates both chocoloate and peanut butter, go figure. An awful lot of this stuff comes as part and parcel of their personalities. It sounds like you have a nice routine that will signal sleepy time to her, and that is a good thing for the long run.

2. Caring for a baby means going through a lot of phases, so easy, some not. I don't know that it's possible to avoid a sleep regression, but just to take each day by day and know that this too shall pass.

3. Daycare will have their own systems worked out for napping. And she will adjust to them, and it will be fine. No need to think about that now.

4. As she gets older you can fiddle with her bedtime. I wouldn't worry about it now, but keep sticking to the routine, and as time goes by you can shift things forward.
posted by ambrosia at 12:44 PM on May 13, 2012

I bet you're going nuts without any time to yourself. I have a baby who hates to nap alone and it drives us a bit bonkers. That plus a relatively late bedtime...yeoch. I feel for you.

It's totally normal for her to wake with a wet diaper. She's sleeping for 10 hours, right? That's a long time for a little baby to go without peeing! They usually don't wake up dry until 2 years or even into school age.

Be super consistent with her bedtime routine, and if she won't stay asleep before 7:45, don't start it until 7:15.

Everything is pretty much "have a routine" or CIO. There's not a whole lot you can do with babies this age. Ferber is a more graduated cry-it-out, Weissbluth is hardcore extinction, No Cry Sleep Solution doesn't involve crying, the Sleep Lady Shuffle is letting them cry/self-soothe while you're still in the room and gradually move further away. If any of these appeal to you, check them out.

That said, even the hardcore CIO stuff is more geared towards 4-month-olds, at the youngest. 14 weeks is still pretty early to be doing this stuff.

Our little guy can go to sleep at night by himself, and we didn't start with that until he was 6 months, and he does pretty great at it. I think the object permanence thing is a bit nonsensical, to be honest.
posted by the young rope-rider at 1:10 PM on May 13, 2012 [1 favorite]

I thought that Healthy Sleep Habits, Happy Child by Marc Weisbluth was great. It's a little confusing (not well organized?) at times but has lots of good nuggets of information. I also thought that Tracey Hogg's books were helpful. Ferber's book called Solve Your Child's Sleep Problems was also useful. I picked and chose from these books to suit our needs but found that they all had information that I could put to use during my kiddos' different ages and needs.
posted by kirst27 at 2:08 PM on May 13, 2012

I guess I should clarify why I mentioned the wet diapers at night. It's because I've been told that at least one sleep training theory says to sooth the child in the middle of the night, but don't change wet diapers or feed the kiddo. If she wakes up at 11, for example, there WILL be a wet diaper and she will be inconsolable unless we change her, so that won't work for my kid. (Not that I don't sympathize; I wouldn't like to hang out in a wet diaper either.)

And yes I adore the cuddles. But since she takes 3 long naps a day, it's hard to go pee, let alone fold laundry or cook dinner. Which was all well and good enough for a while, but at this point it would be helpful to have a few minutes a day to use the bathroom and get stuff done. Of course I can just do it and wake her up and let her scream and sometimes I have to (or invest in adult diapers) but I'd rather put her down for at least one nap a day if there's a way to do that.
posted by semacd at 2:53 PM on May 13, 2012

Oh, wow. I hear you. At one point I was seriously worried about getting a blood clot in my legs because of the amount of time I spent motionless with a baby on my lap. It's crazymaking.

When you say that she sleeps through the night, do you mean that she is sleeping without waking up at all? Or that she goes to sleep easily after she does wake up?

We still swaddle my 7-month-old and it helps him stay asleep for longer naps, if that's something your little one finds soothing.

I can second Weissbluth, although it is a bit confusing, it'll help with reasonable sleep expectations.
posted by the young rope-rider at 3:04 PM on May 13, 2012

Perhaps it's just semantics, but your description does not sound like "sleeping through the night." It does sound like you've been conditioning her to only fall asleep with your assistance. I think self-soothing -- both for naps and overnight -- is something you could research and work on. As far as diapers, are you using the overnight style? (I'm assuming you're using disposables). If not, they might help as they absorb more pee. In any event not changing a wet diaper just seems crazy and a recipe for rash.

Fourteen weeks is a little early for sleep training in earnest, particularly any kind of extinction/CIO. Five months is generally considered the earliest, as the production of melatonin becomes more regular around this time. (Although that's an American practice, the French start much sooner and more gradually for example).

Regarding books, I've seen only two authors that pass muster as pediatricians grounded in empirical research; not coincidentally they are the canonical experts accepted by the vast majority of mainstream pediatricians (in the US). Marc Weissbluth's book is more about habits and day-to-day, and has a more holistic take on sleep in family life. He really stresses that good sleep is critical to the health and development of kids. Richard Ferber's book is more about treating problems. It's first chapter is a superb summary of what we know about infant and child sleep. (don't let people scare you about "Ferberization," if you actually read the book his tone is like the Mr. Rogers of sleep. His approach is actually gentler than Weissbluth and has been revised to incorporate co-sleeping and all kinds of other AP shenanigans). I do agree that the Weissbluth book could be a lot better organized.

I would start with Ferber, in particular the concept of "sleep associations." One you understand that concept it's like a lightbulb going on, and you realize that your child really doesn't need to be held/rocked/nursed/patted etc. to sleep and that the whole family will be better off if you end those habits.
posted by werkzeuger at 3:51 PM on May 13, 2012

Re "sleeping through the night"... She regularly falls asleep (sometime between 7:45 and 10 depending on the bedtime battle du jour) then wakes us up between 5:30 and 7:30. So from what I hear, that's "sleeping through the night," right? It's amazing. We can't plan on it because she also regularly wakes up to nurse and have her diaper changed, 1-3 times per night. We have no clue why some nights she sleeps longer/better than others. I'm not ready to phase out the nighttime feedings because she seems starving when that happens, and not changing her wet diaper isn't an option. Any amount of wetness drives her to distraction.

I'm not thinking about CIO until she's at least 4.5 months, though I may be amenable to it then. And she does nap next to me in bed during the day, but I'm afraid she'll roll off so I never leave her alone in our bed.

I guess what I'm asking is - is there a functioning theory that will help her to fall asleep in her crib at bedtime, in the middle of the night, and maybe even during the day? If so, which theory/book?
posted by semacd at 4:41 PM on May 13, 2012

So in my experience (1 kid, totally anecdata) it goes something like this: for the first 8 months, do whatever you need to do to get the baby to sleep (nursing, swinging, swaddling, wearing, etc.), try sleep training, fail, keep doing whatever you need to do until the baby has his first birthday, totally reach your breaking point, try sleep training again, be totally amazed when it works after only one night.

My kid nursed to sleep every night for the first year, and yet when we tried the Sleep Lady in earnest shortly after his first birthday, he got it right away and has been falling asleep on his own ever since. Kids are pretty adaptable, and I think they are ready for this stuff at their own pace. FWIW my pediatrician told me at 3 months that it was a good time to sleep train but I knew my kid wasn't ready. At 8 months he still wasn't ready.

I guess my point is, you're not going to miss your one and only chance to give your baby good sleep habits if you don't start right now. It will come.
posted by rabbitrabbit at 4:42 PM on May 13, 2012 [2 favorites]

That should read 4 months, not 3, sorry.
posted by rabbitrabbit at 4:46 PM on May 13, 2012

And I guess my other point is, you can try sleep training at any age but it will only work when the child is ready. And 14 weeks sounds way early to me, at that age it seems to me you're at the mercy of the baby's sleep cycles. I'm not sure if they're developmentally capable of soothing themselves to sleep that early.
posted by rabbitrabbit at 5:07 PM on May 13, 2012 [1 favorite]

I guess what I'm asking is - is there a functioning theory that will help her to fall asleep in her crib at bedtime, in the middle of the night, and maybe even during the day? If so, which theory/book?

Yep, absolutely! It's the "sleep association" concept I referred to above. Here's how I understand it:

All humans, babies and adults, wake periodically through the night. It's completely normal. As an adult you roll over, maybe move your pillow a little, whatever. You also subconsciously check your environment to make sure everything's okay, and that conditions are the same as when you fell asleep--no weird noises, smells, still dark, etc. If something is amiss, even if it's simple like your pillow fell on the floor, then you wake up a little more to fix the problem.
Well, babies are the same. They wake up in the middle of the night even more than adults do, and they check to see if things are okay and it's safe to go back to sleep. They really want the conditions to be the same as when they fell asleep. Ferber puts it this way (I'm paraphrasing from memory here):

"Imagine if you fell asleep every night on the couch with a light on but woke up several hours later in your bed, in the dark. You'd be freaked out, right? What happened? How did I get here?"

This is what happens when you, say, rock your baby to sleep in the living room and then tiptoe ever so quietly into their room and drop them carefully into their crib, all the while crossing you fingers. I used to do this! It sucks, and it took me until they were almost five months old (and I was near-suicidal from sleep deprivation) to learn that it's wrong.

The point of "self-soothing" and "sleep training" in general is to make a positive sleep association, i.e. their crib in a dark quiet room. When they wake up, save for a wet diaper or true hunger, everything is as it should be and they can fall back to sleep by themselves. Right now they wake up, miss your arms, or rocking/movement, and they don't know how to fall asleep again without that. There are a variety of things you can try to reinforce that positive association, and the Ferber and Weissbluth books spell out in detail those methods and under what circumstances they are appropriate. And CIO is just one of those methods, and itself has many variations.

Also, I want to say as an aside I really respect the thoughtfulness you're displaying about this issue. I've been there, and I know how stressful sleep issue with babies can be. It sounds like you're doing a great job.
posted by werkzeuger at 5:48 PM on May 13, 2012

Weissbluth's book read like a very knowledgeable person's notes for what could be a better book. As a working, sleep-deprived parent I couldn't deal with it.

Mindell's "Sleeping Through the Night" is an easier read.

"The Sleep Lady's Good Night, Sleep Tight" book may be closer to what we've ended up doing (though I couldn't read the whole thing--I found it long and repetitive).

My wife more-or-less vetoed ever leaving the baby crying alone, but books advising that still had other useful ideas.

Timing is hard: his "I'm sleepy now" signs aren't always obvious.

Records help some. We use quad-ruled graph paper: one row per day, one column per hour, so we can quickly see when he usually sleeps.

He's slept better as he's matured, but there's research suggesting problems can persist a long time, so I'm wary of assuming he'll grow out of any problem. Working on "sleep associations" (nursing specifically) helped in our case (unless it was a coincidence).

(Current status: at 13 months he goes to sleep on his own at night and doesn't need us till he wakes up happy in the morning. Naps are more chaotic and require rocking. If I rock him to sleep he'll consent to be transferred to his crib, so that at least frees mom from human mattress duty. I'm fortunate to be a telecommuter with a flexible work schedule.)
posted by bfields at 7:07 PM on May 13, 2012 [1 favorite]

Also - every baby is different. I have five kids and they all have different sleep habits, and they have all changed their sleep habits. My friends with babies have all used different methods to different levels of success. The most crazed are the ones who believe that there is only One Way, usually from a first successful child, and can't get it to work on another child.

Try stuff for about a week to two weeks, see if it works. Your baby sounds like she is very happy and has great cues to communicate clearly what she wants/needs about diapers and sleep and being close to you already.

I have compromised with my infant daughter to have her sleep first against my legs on the bed, not on my lap, and then to move her further away, holding onto my hand. It doesn't always work, but it's mostly working so I can use my computer while she naps.

You may be putting her to sleep when she's not actually sleepy. Try giving her another hour of low-impact activities - playing quietly with toys or just being carried around - and when she starts looking sleepy, laying her down. It may turn out that she's only sleepy at about 9pm-ish.

We let ours sleep when they're sleepy (with rules like you have to be in your bed by X hour) because it is very difficult, even as an adult, to force yourself to go to sleep, and a baby can't yet make that decision. Our youngest has decided that she will sleep from 6pm to 9pm, then from 11pm to about 6am now, pretty consistently, so we work around that. I have another kid that would sleep from 1am to 10am if possible, so he has to have daytime naps to make up for waking at 6am and is allowed to stay up later in his room.

One thing that's helped me is that babies have two types of sleep, light and dreaming, and deep. The light dreaming sleep is more frequent, and they can get easily startled out of it, but also fairly easily soothed back into it. The deep sleep is when they slump completely still and breathe very slowly and you can't wake them easily from it. I try for a totally quiet room with the dreaming sleep or I sit near her so I can soothe her back to sleep, but with the deep sleep, I'm fine for at least an hour to leave her be and not worry about noise.
posted by viggorlijah at 7:47 PM on May 13, 2012

I don't think any babies are "ready to sleep train" until 6 months. Those who start earlier will -- surprise! -- have stories about trying one thing or another for several weeks (ahem) until they "found the thing that worked" which is mostly waiting until the kid was old enough to learn. It does help to put them down drowsy, not asleep, from the start, but your kid is already used to falling asleep with motion/assistance, so that bird has flown. Just try to inch it up as much as possible, but there's no point in pushing hard until you're ready to follow through with some amount of crying (= systematic sleep training of some sort).

You might be able to use the pacifier as a bridge -- i.e., try a pacifier when she first wakes/cries, and see if she can fall back to sleep without a whole additional start-from-scratch routine, but I wouldn't feel terrible if this doesn't work.

I agree with "whatever it takes to survive" -- find a baby-wearing solution that lets you go to the bathroom without having to set the baby down, or make sure you have a bouncy seat that she loves (one that buzzes might do the trick, or a swing), or another set of hands to take a turn, or just arrange the occasional day off to get your sanity and rest back, and if you can hold on another couple of months, you can just let the kid cry and trust that she'll be ready to self-soothe. Those first months are long ones, but This Too Shall Pass!!
posted by acm at 8:08 AM on May 14, 2012

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